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INJURED WORKER FIRST FILL PRESCRIPTION FORM (FOR NEW INJURIES ONLY)Injured Worker Instructions: On the first visit to a network pharmacy (Target, Walmart or any off of the attached list), please give
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How to fill out for new injuries only

01
First, assess the severity of the new injury.
02
Clean the wound with soap and warm water to prevent infection.
03
Apply an antiseptic or antibiotic ointment to the wound.
04
Cover the injury with a sterile bandage or dressing.
05
If the injury is bleeding heavily, apply pressure using a clean cloth or bandage.
06
Elevate the injured body part if possible to reduce swelling.
07
Seek medical attention if the injury is severe, such as deep cuts or fractures.

Who needs for new injuries only?

01
Anyone who has recently sustained a new injury, such as a cut, scrape, or sprain, needs to follow these filling out instructions.
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For new injuries only refers to injuries that occur after a specific date and are not related to pre-existing conditions.
The person who experienced the new injury is required to file for new injuries only.
To fill out for new injuries only, you must provide detailed information about the new injury, including the date it occurred and how it happened.
The purpose of for new injuries only is to ensure that recent injuries are properly documented and addressed.
The information that must be reported on for new injuries only includes the date of the injury, how it occurred, and any immediate actions taken.
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